11 Jul 2013
For the person who has fought back against drug addiction and has been walking the road of recovery, stress can pose a dangerous threat. For many, the stress of struggling to find work, rebuild relationships, or a sudden loss through death can be enough to trigger a return to using drugs. Stress is a powerful force for people without an addiction history, but when there has been a pattern of soothing stress with substances, the temptation to do so again when the stress temperature rises is great. A recent National Institutes of Health-funded study may have discovered the key to preventing stress from triggering that kind of relapse.
The grant-funded study was actually a partnership between researchers from the University of Pennsylvania and Brown University. The investigation provides a clear outline for the sequence of events within the brain leading up to a stress-induced drug relapse. The study debunked prior hypotheses about the relapse pathway and uncovered evidence that the part of the brain connected to meeting basic needs (the VTA) was pivotally involved.
The study employed rats with a history of cocaine addiction but who were not presently addicted. Some of the rats were treated with a chemical (nor-BNI) that inhibits certain VTA receptors (known as kappa opioid receptors), while the other group of rats did not receive the treatment. Next, all of the rats were made to undergo five minutes of stress-inducing exercise. Observation showed that the treated rats did not revert to cocaine use even after being stressed. The non-treated rats did go back to cocaine.
When we meet our body’s essential needs such as eating and drinking, the brain releases dopamine, a chemical that rewards our behavior with a sense of pleasure. At the same time, healthy brains also release GABA, which modulates dopamine release. Drugs keep GABA from doing their job of controlling the dopamine flow and hence drug use produces an oversized rush of good feelings.
Relapse Prevention with Stress Prevention
In this study, researchers first demonstrated that stressors prevent GABA from slowing down dopamine release. This explains how stress can be a preamble to drug relapse. In the presence of stress, the proper amounts of reward chemicals are disordered. Pleasurable activities become inordinately pleasurable. However, the study team showed that by introducing nor-BNI into the VTA area of the brain, the dopamine controls remained in place even during periods of stress.
By honing-in on the neural underpinnings of a stress-caused relapse, these scientists may have found a way to interrupt the chain reactions that trigger a return to drug use. The study could prove to be a major leap forward toward creating a targeted medication that could remove a domino from the stack and prevent the inevitable result.
Finding a rehab that has not only a great rehabilitation program but a great aftercare program is another way to help prevent relapse. Read Choosing the Right Drug Rehab for Your Loved One to learn more.
Reporting the news in Mexico can be a deadly occupation, especially for those covering the drug war. But where militant thugs have been successful in stifling the media, they are virtually powerless against those who have taken to social media to “report” the war.
It’s not only Mexican residents caught in the crossfire taking to Twitter, YouTube and Facebook, those across the border in the U.S. are also using social media as a tool. Residents are using social media to protect themselves from the drug cartels that stop at nothing to push their product and protect their turf.
The violence began in earnest when the Mexican president declared war on drugs, but crept up another few notches when two major partnering cartels split and declared war on each other. Since the declarations of war, it is estimated that as many as 100,000 people have been killed and another 30,000 have seemingly vanished into thin air. Many residents try to escape the most violent areas, which has put more than 200,000 in a displaced status.
Some of the only news sources available now are through Twitter and Facebook. While news footage once came from the major broadcast companies in Mexico, camera phones with crudely edited footage of the war between the government and the cartels is being placed on YouTube instead. Media outlets in the U.S. are also depending on these amateur videos as their go-to source for footage.
America’s ongoing drug dependency is fueling this war. About 90 percent of illicit drugs making their way into the U.S. are coming through Mexico. The biggest cash crop, so to speak, continues to be cocaine.
According to the National Institute on Drug Abuse, nearly 5 million Americans said they had at one point or other abused cocaine. While those numbers pale in comparison to the drug’s peak in 1982 (10.5 million were believed to be using the drug in that year), it’s still enough to fuel a drug war that is taking lives.
Addiction can be challenging to treat, and some addictions are particularly so. For example, many individuals who enter a substance abuse treatment center for cocaine addiction and complete the treatment program soon return due to relapse. The tools acquired in treatment for dealing with cravings are sometimes not effective in patients who have a particularly challenging case of addiction to cocaine.
A new study indicates that there may be help for those who have a cocaine addiction that does not respond to traditional treatments. While there has been little success in treating cocaine addiction with medications, the study finds that this strategy may be effective in certain situations.
Disulfiram is a medication that has been approved for treatment in alcohol addiction for 50 years. Its effectiveness is rooted in the blocking of acetaldehyde metabolism, causing acetaldehyde to build up in the body. The result is an unpleasant mix of nausea, headache and vomiting, accompanied by an increased heart rate. Those who take Disulfiram may quickly learn to avoid drinking alcohol.
Based on previous studies at Yale University that linked a Disulfiram-related reduction in the use of cocaine when paired with alcohol or opiate dependence, researchers recently published new findings in the journal Biological Psychiatry that support the use of Disulfiram in treating cocaine addiction.
The study’s findings show that Disulfiram is able to inhibit dopamine ß-hydroxylase, or DßH, which is an enzyme responsible for the conversion of dopamine to norepinephrine.
Led by Thomas Kosten, the researchers examined Disulfiram’s effectiveness among cocaine and opioid dependent participants who received either the medication or a placebo over a ten-week period.
The researchers also genotyped the DßH gene, which controls the levels of the enzyme to determine which variant of the gene was present in each patient. The researchers wanted to determine whether the variant impacted the success of the Disulfiram as a treatment for cocaine addiction.
The study results showed that Disulfiram was effective in reducing the use of cocaine among the participants according to the DßH gene variant they possessed. The data supported the researchers’ expectation that Disulfiram impacted cocaine consumption by blocking DßH.
The researchers note that there was a significantly greater effectiveness related to Disulfiram use among those participants that carried the genetic variant, and this accounts for perhaps about 60 percent of cocaine addicts. This supports the use of pharmacogenetic matching to establish the best strategy for treatment of cocaine addiction.
The findings are particularly promising, given the challenge that has been connected with treatment for cocaine addiction. While the medication may not effectively treat every individual with cocaine addiction, it may help close the gap for those who carry the necessary genetic variant.
North and South America have half of the world’s heroin abusers, 45 percent of cocaine users and a quarter of marijuana users, according to a report from the Organization of American States (OAS). The current approach, the “war on drugs,” is severely lacking in support in the modern day, with numerous experts suggesting a more liberal strategy that re-phrases drug use as a health issue rather than a criminal one. This idea has been yet again proposed in a 200-page report from the OAS, urging American leaders to rethink their policies in the interest of users across the continents. Their argument takes several stands, looking at addiction as a health problem, considering the severe harm done by the drug trade, and the financial impact on both law enforcement and organized crime groups.
The Drug Use Report
The purpose of the report was to prevent a starkly realistic portrayal of the impact of drugs across the Americas. José Insulza, secretary general of the OAS, said it is intended “to show the volume of money that changes hands and who benefits from it; to show how it erodes our social organization and how it undermines the health of our people, the quality of our governments and even our democracy.”
In addition to this, the report looks at the policies that have been implemented to date and the consequences if the problem isn’t dealt with more intelligently. The overall conclusion is that increased access to treatment, reduction of criminal punishments for use of drugs and strategies tailored to the conditions in the individual countries are the best approaches.
The Drug Trade
The damage done by the drug trade is one of the key points raised to support the viewpoint. As an example, Latin America produces essentially all of the cocaine consumed by Western users. The trade is run by criminal organizations, which have risen in power and come to undermine the rule of law in the region, breeding corruption, creating violence and destroying human rights. Human rights activists and journalists who expose the violence and politicians who refuse to be corrupted are at significant risk. The biggest damage, however, is to citizens caught in the crossfire between criminal gangs. Overall, the drug trade kills thousands each year across places like Central America, Mexico and Columbia.
The current system is financially beneficial only to the criminal gangs who supply and produce the illicit drugs. Nobody would buy alcohol from a gang, because it is available across the Americas and the companies who make it have standards to abide by. The black market in drugs, however, relies on those gangs entirely. According to the secretary general Insulza, this generates around $151 billion in retail for the gangs across the continents. This funds other illicit activity, and the industry also saps money from governments on both continents. In 2010 alone, the US spent $15 billion on the war on drugs, both internationally (significant chunks of the money goes to Columbia, for example) and domestically. The current system, in short, is a financial black hole.
Drug Abuse: It’s a Health Issue
The core message of the document is that addiction is a public health issue, not a criminal one. This has been stated numerous times, but the report emphatically states that decriminalization of drug use should be the basis for all public health strategies. It echoes the commonly stated criticism that addicts shouldn’t be punished for having what is widely recognized as an illness.
Drug addiction reprograms the addicts’ brains to crave drugs, so the choice to continue to use an illicit substance isn’t a moral failing; it’s more like a diabetes-sufferer having hyperglycemia after unknowingly consuming a sugary snack. Drug cravings are a symptom of an illness in exactly the same way hyperglycemia is a symptom of reduced insulin production. Perhaps the diabetes sufferer consumed too much sugary food throughout his life and consequently developed type 2 diabetes, but we don’t morally chastise him for it. Drug users have a mental health issue, which requires treatment as opposed to criminal punishment.
Sounds Good, But Is There Enough Support?
The reduction of penalties for drug abuse is obviously vital to this approach, but the support for the idea is rarely in line with the recommendations. The report isn’t in favor of legalization of all drugs—it advocates legalization of marijuana but suggests a decriminalized approach for other drugs. This would essentially render drug offences legally equivalent to traffic violations, which are rarely jail-worthy. While some of the 35 member states are receptive to the legalization of marijuana, they didn’t find any notable support for the decriminalization of any other currently illegal drug.
Despite this predictable setback, the report adds to a growing body of thought which should be nagging at politicians all over the world. Criminal approaches to tackling drug abuse don’t work; it’s essentially a punishment for suffering from a health condition. While it may be easier to avoid controversy if the idea is quietly brushed aside, you can only metaphorically cover your eyes and pretend you don’t see the evidence for so long.
30 May 2013
An article in the Australian Business Review Weekly tells the story of “Ruth,” a high finance worker in Sydney who left her job because she wanted to stop snorting cocaine. According to her story—which was told to an Australian rehabilitation worker—substance abuse was a 24-hour habit in her business, with executives constantly sneaking off to the bathroom for a pick-me-up.
Substance abuse specialist Josette Freeman argues that it isn’t unusual in that sort of industry, claiming that meetings over wine and dinner with clients often descend into cocaine-taking, and even that the high stress and production-focused businesses essentially reward drug abuse by ignoring the issue if it benefits them. In the United States, it’s estimated that business owners lose $100 billion per year as a result of drug abuse—and the facts about its impacts don’t paint the sort of picture these businesses might imagine.
“Benefits” for Businesses
According to the US Department of Health and Human Services, in 2009 77 percent of illegal drug users had either part time or full time jobs. Given the high rates of substance abuse amongst lawyers, it seems reasonable to assume that other high-level professions will also be affected.
If you place yourself into the shoes of a business-owner or other employer (with a limited capacity for foresight), you can see that there are several superficial benefits to a drug-using workforce. Most drugs don’t even have these, but stimulants like cocaine generally increase alertness, help people stay awake, improve mental performance and reduce appetite. If you think coldly and callously, as if you’re only interested in making a profit, these effects are big plus-points for stimulant use in the workplace. You feel like you’ll get an active, focused and dedicated work-force, willing to pull long hours and with an almost constantly positive morale.
According to Josette Freeman—whose work for drug rehabilitation group SMART has put her in contact with many white-collar addicts—“there are a lot of workplaces where they don’t care too much about the workers if they are producing.” This is at least echoed in the legal profession in the US, where the problem is often ignored and allowed to continue.
Risk Factors for Workplace Drug Abuse
There are numerous different elements which can make workplace substance abuse more likely. A particularly important one is stress (which will be addressed in detail later) but many other factors such as long or irregular shifts, tiredness, repetitive duties, isolation, ease of access to substances, lack of supervision and low job satisfaction are also notable risk factors. Some of these (such as stress, tiredness and long hours) would typically be more likely to affect higher-level workers, but others (such as repetitive duties and low job satisfaction) are a particular concern for blue-collar workers. Regardless of the specific risk factors, most jobs evidently carry some inherent risk of substance abuse.
The Importance of Stress
Stress is a key factor when it comes to any type of substance abuse, and this is particularly relevant for high-level professions that carry a lot of responsibility. The mechanism by which stress contributes to addictive behavior has also been studied, but it’s important to understand that stress only creates a susceptibility to addiction. It all depends on how individuals deal with the stresses of the workplace. Healthy coping mechanisms that don’t rely on substances enable most workers to manage stress without relying on substances as a mood-elevator. However, not everybody has these coping mechanisms.
For individuals with less healthy stress management strategies, a high-stress job in the financial or legal industries can easily lead them down the road to substance abuse. As mentioned in the previous section, this is particularly likely if there is easy access to substances in the workplace. This means that if there is a “culture” of drug abuse in the office, anybody exposed to high levels of stress is especially likely to get sucked in. To truly combat the issue of workplace substance abuse, employees have to be taught healthy coping mechanisms and about the long-term effects of drug abuse in the workplace.
The Truth of the Matter
As you may expect, workplace drug abuse—which may have an initial appeal to some employers and employees—ultimately reduces productivity, increases the number of absences, and makes regular changes in employer even more likely. Even stimulants, which initially seem like productivity-drugs, can cause panic, aggression, suicidal thoughts, paranoia, and hallucinations in chronic (long-term) users. On top of this, stimulant users ordinarily binge and then “crash” in a period of little activity characterized by depression, anxiety, and cravings.
Workplaces need to remain vigilant against drug abuse, and it’s advisable to have a policy in place for dealing with workplace substance abuse. In addition to educational programs to increase awareness, it’s important for employers to provide access to treatment and support. Businesses should also be clear about testing protocols and commit to disciplinary action where required. It’s a problem that spans all workplaces, and all businesses must take steps to protect against it.
Read more about The Dangers of Recreational Drug Use Here
15 Apr 2013
Enlarged heart is a term that doctors use to describe a heart muscle that grows beyond its expected size, either on the whole or in part. Some forms of heart enlargement, such as those frequently found in habitual exercisers, can support improved cardiac health. However, other forms of heart enlargement make the heart increasingly dysfunctional and set the stage for life-threatening problems such as a heart attack and cardiac arrest. Cocaine use can lead to a form of heart enlargement that seriously increases risks for cardiac arrest and sudden, unpredictable death.
The muscle content of the heart, called the myocardium or myocardial tissue, gives the organ the power it needs to contract and pump blood. The primary pumping chamber—known as the left ventricle—forms the lower left segment of the heart, while the secondary pumping chamber, known as the right ventricle, forms the lower right segment of the organ. The left ventricle moves oxygen-rich blood to the body’s arteries; the right ventricle moves oxygen-depleted blood to the lungs, where new supplies of oxygen enter the bloodstream. The upper left chamber of the heart—known as the left atrium—carries oxygen-rich blood to the heart from the lungs, while the upper right chamber, known as the right atrium, carries oxygen-depleted blood to the heart from the rest of the body.
The medical term for heart enlargement is cardiac hypertrophy. This phenomenon occurs when the muscular walls of the heart (i.e., the myocardium) grow unusually thick. When unusual thickness appears in either of the ventricles, the affected individual has a condition called ventricular hypertrophy; when unusual thickness appears in either of the atria (plural of atrium), the affected individual has a condition called atrial hypertrophy. As noted previously, some forms of hypertrophy can make the heart work better. For instance, athletes and regular exercisers can develop a form of ventricular hypertrophy that makes it easier for the heart to pump blood to the lungs or other parts of the body. However, as also noted previously, some forms of hypertrophy reduce the heart’s effectiveness. This typically occurs when enlargement scars and stiffens the walls of the ventricles, and thereby decreases their ability to contract and pump blood.
Damaging forms of heart enlargement are known collectively as pathological cardiac hypertrophy. Apart from cocaine use, potential underlying causes of damaging enlargement include chronic high blood pressure, a heart attack, disease in any of the valves that sit between the heart’s chambers, and heart failure. Typically, unhealthy heart enlargement develops gradually over time; however, in certain circumstances, it can also develop relatively rapidly. In many cases, dangerous cardiac hypertrophy produces no symptoms until its effects are relatively advanced. For this reason, people with the condition can die suddenly from a heart attack or from an abrupt stoppage of heart.
The Role of Cocaine
Cocaine use causes heart enlargement through a unique series of health changes, according to the results of a study published in 2006 in the Journal of Cardiovascular Pharmacology. First, the presence of the drug in the bloodstream activates a specialized type of protein (enzyme) called CaMK; in turn, activation of this enzyme encourages an abnormal buildup of the mineral calcium in the heart’s tissues. When calcium builds up in the heart, it promotes the accumulation of other proteins that normally only appear in the hearts of developing fetuses. When they first appear, these immature proteins increase the size of individual cells inside the myocardium. Eventually, enlargement spreads to larger areas of tissue and triggers the onset of cardiac hypertrophy. Typically, this process occurs in the heart’s primary pumping chamber, the left ventricle.
People who habitually use cocaine can develop degrees of hypertrophy that enlarge their left ventricles by up to 70 percent, the authors of a study published in 2003 in the Journal of Cardiovascular Pharmacology and Therapeutics report. The amount of enlargement associated with long-term cocaine use can weaken the left ventricle to the point where this chamber can no longer meet the strict timing requirements necessary to coordinate heart activity and efficiently pump blood. In turn, lack of proper heart beat timing can lead to serious forms of a condition called a heartbeat irregularity, or arrhythmia.
The degree of arrhythmia associated with long-term cocaine use can lead to unsustainable changes in heart rhythm and the unpredictable, frequently fatal appearance of cardiac arrest. Unlike people with chronic heart disease, cocaine users can easily develop enlargement-related cardiac arrest without developing symptoms—such as high blood pressure or an increase in resting heart rate—that cue doctors to the possible presence of dangerous changes in normal heart function. According to the authors of the study published in 2006 in the Journal of Cardiovascular Pharmacology, as many as half of all habitual cocaine users with normal blood pressure may have some degree of heart enlargement.
The blood-brain barrier (BBB) is a network of tiny blood vessels (capillaries) that separates the interior of the central nervous system (brain and spinal cord) from the rest of the body’s circulatory system. This separation is required to help the brain maintain a stable internal environment and function properly; it also helps protect the brain from infectious microorganisms. Cocaine and methamphetamine can significantly damage normal function in the blood-brain barrier; in turn, this damage can open up the brain to infection and other processes that can produce severe or life-threatening changes in brain health.
Blood-Brain Barrier Basics
Capillaries are the body’s smallest blood vessels. They sit at the junction between the arteries—which carry oxygen-bearing blood to various organs and tissues—and the veins, which carry oxygen-depleted blood and carbon dioxide waste from the organs and tissues to the heart (on the way to their eventual destination point in the lungs). It’s inside the capillaries where exchange of the oxygen and carbon dioxide content in the blood occurs.
In every location except the blood-brain barrier, the capillaries have relatively large openings in their walls that allow large and small molecules to move in and out of the bloodstream. This level of access means that any required substance produced in most of the body can easily travel through the bloodstream and get where it needs to go. However, it also means that conditions in the tissues fed by the capillaries can change rapidly and relatively chaotically as different molecules move in and out of circulation.
The central nervous system in general (and the brain in particular) can’t handle the sorts of fluctuations that occur when all molecules can flow easily through the capillary walls. In fact, these fluctuations would destabilize the brain to the point where it wouldn’t be able to perform its function as the body’s command and control center. In addition, if any molecule could easily enter the central nervous system, then infectious microorganisms could get to the brain and wreak all sorts of havoc on the organ’s structures and activities. In order to help prevent these possibilities, the capillaries in the BBB are very tightly constructed and lack the large openings found in other capillaries. In addition, supporting cells (called astrocytes) sit in the barrier outside the capillary walls and further block any influx of unwanted molecules and microorganisms.
The Effects of Cocaine and Methamphetamine
For a number of reasons having to do with how cell walls are constructed, molecules that dissolve easily in the presence of fat can pass directly through the capillary walls in the blood-brain barrier. Among the molecules that can access the central nervous system in this way are cocaine and methamphetamine. Once inside the central nervous system, these drugs produce mind alteration and a variety of other effects by altering the normal levels of certain neurotransmitting chemicals—such as dopamine, norepinephrine and serotonin—that support proper brain function by passing on required messages between millions of nervous system cells called neurons.
One of the consequences of neurotransmitter alteration by cocaine and methamphetamine is a significant increase in the amount of heat retained inside the brain and body. If heat levels get too high, they can trigger a condition called hyperthermia, which literally means “overheat.” In turn, hyperthermia can produce serious damage in the capillary walls inside the blood-brain barrier and lead to the formation of significant gaps that give access to dangerous molecules not usually allowed into the central nervous system’s restricted environment.
Apart from its role in hyperthermia, cocaine produces chemical changes in the capillary walls that lead to the formation of abnormally large points of entry through the BBB, according to a study published in 2010 in Blood, the journal of the American Society of Hematology. These chemical effects are particularly prominent in cocaine users who have HIV infections, and the authors of the study believe that the relatively rapid advancement of HIV’s brain effects in cocaine users stems from the ability of both cocaine and HIV to damage the capillary structures in the blood-brain barrier. Cocaine may also damage the BBB by increasing the flow of blood plasma to the brain, or by encouraging an excessive flow of the neurotransmitter serotonin from the body to the brain. In addition to its role in hyperthermia, methamphetamine can apparently damage the blood-brain barrier through a direct, toxic effect on the capillaries within the barrier.
Doctors and researchers have long looked for a medication capable of easing the effects of cocaine addiction. For a variety of reasons, their past efforts haven’t been successful, and there is no single medication on the market capable of filling this role. However, current evidence indicates that two other medications-buprenorphine and naltrexone-that were initially designed for other purposes, apparently work in combination to ease cocaine addiction and facilitate successful participation in cocaine rehab programs. Doctors usually use buprenorphine to treat opioid addiction, while naltrexone is used to treat both opioid and alcohol addiction.